CMS/EIP Fiscal Report Center: 02
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 Page: 1
Payclass Filters:GR
Eligibility Filter:Not Part C
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 22 14.75 545.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 2 3.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 30 49.50 1831.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 19 67.00 2451.25 36.59
Subtotal (Total Children Is Unduplicated) 39 134.25 4828.50 35.97
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 10 16.00 1199.50 74.97
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 6.00 450.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 15.50 858.75 55.40
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.00 375.00 75.00
Subtotal (Total Children Is Unduplicated) 15 42.50 2883.25 67.84
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EI Services,Class #03
INTR-INTR-INTERPRETER 2 7.25 337.50 46.55
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 23 2362.00 1180.71 0.50
Subtotal (Total Children Is Unduplicated) 23 2369.25 1518.21 0.64
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Total 2546.00 9229.96 3.63
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Number of Children (Unduplicated) With at Least One Service 40
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Center 02
Flag Claims Units Chgs Paid
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R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 60 2264.00 3793.96 3793.96
165 282.00 5436.00 0.00
Other 0 0.00 0.00 0.00
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Total 225 2546.00 9229.96 3793.96